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General NPI Number Information
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NPI Number | 1083714190
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Entity Type | Organization
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Legal Business Name | NORTHERN INDIANA OCCUPATIONAL MEDICINE SERVICES LLC
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 813 LAPORTE AVE
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City | VALPARAISO
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State | IN
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Zip | 46383-5801
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Country | US
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Telephone | 219-465-4950
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Fax | 219-548-3172
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Provider Business Mailing Address
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Address Line | PO BOX 2028
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City | PORTAGE
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State | IN
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Zip | 46368-5528
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Country | US
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Telephone | 219-762-4050
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Fax | 219-762-7814
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Authorized Official
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Title or Position | ACCOUNT MANAGER
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Name | MS. ANGELA LEICHT
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Credential |
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Telephone | 219-763-6423
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number |
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License Number State |
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